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Flow-directed micro-catheterisation technique over a detachable coil.

Henrik Ullman1, Jesse Jones1, Naoki Kaneko1

  • 1Department of Radiology, UCLA Medical Center, Los Angeles, California, USA.

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|September 7, 2019
PubMed
Summary

A novel technique using a platinum coil facilitated embolisation of a complex neonatal vein of Galen malformation. This coil-directed approach offers a safer alternative for treating fragile neonatal brain vasculature.

Keywords:
congenital disordersinterventional radiologyneuroimagingradiology

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Area of Science:

  • Interventional Neuroradiology
  • Paediatric Neurosurgery
  • Vascular Malformations

Background:

  • Neonatal arteriovenous shunts present unique endovascular challenges, including tortuous vessels and limited device availability.
  • Treating vein of Galen malformations (VGAM) in neonates requires specialized techniques due to anatomical complexities and fragile vasculature.

Observation:

  • During embolisation of a choroidal-type VGAM in a 9-day-old infant, an extremely tortuous posterior choroidal artery pedicle was encountered.
  • Conventional over-the-wire micro-catheter selection proved difficult in the tortuous feeder vessel.

Findings:

  • A platinum coil was advanced through the micro-catheter, with high flow directing it anterograde.
  • The micro-catheter was then advanced over the coil's pusher wire to the target lesion, enabling facile embolisation.
  • This coil-directed micro-catheter technique successfully navigated the tortuous anatomy.

Implications:

  • This method provides a potentially safer alternative to traditional guidewires for neonatal embolisation, reducing perforation risk.
  • The technique is adaptable for various embolic agents, including coil and liquid embolics, expanding treatment options beyond n-Butyl cyanoacrylate.
  • This approach enhances the management of complex neonatal brain vascular malformations.